Covid-19 Response: Making Face Masks

In contradicting what we’ve been taught until now – that face masks are not useful – I fully expect this post to be controversial. But too much is at stake, so please read on with an open mind.

The good news from Seattle is that our current lockdown seems to be working. New infections appear to be leveling off. It’s too early to tell whether this will last, but it’s encouraging: We aren’t powerless. We can change the trajectory of this pandemic. Unfortunately, the situation is more difficult in many places, and our thoughts go out to all who are affected. It’s a scary time!

And yet we must focus on the future. Now is the time to prepare for the fight against the virus after we start returning to normal life. The ‘shelter-in-place’ orders reset the clock by reducing transmissions, while we try to figure out who is infected and who is not. Once we come out of the lockdowns, the virus will still be in the community. There will be fewer carriers, but many will be asymptomatic.

What may seem like bad news – this won’t be over for a long time – is also good news: We get another chance. And this time, we can take measures that – hopefully – will contain the virus before we need to take drastic measures – such as lockdowns – again. We all want to return to our normal lives. The more we prepare and get it right this time, the more we will be able not just to return to normal, but also remain at normal.

This is where everybody has to help. What can we do? The obvious is continue safe practices:

  • Take social distancing seriously.
  • Wash our hands frequently (and for the full 40 seconds).
  • Disinfect surfaces that we touch before we can wash our hands. Keep our bathrooms clean (and separate, where possible).
  • Wear masks when we are out in public. (Yes, really!)

Masks appear to be one of several reasons why infections did not spike as rapidly in Hong Kong, South Korea and Singapore. Everybody there wore masks during the outbreak, making the social distancing more effective.

The evidence on this is clear: Scientific studies have shown that a surgical mask will reduce exposure to airborne viruses, on average by a factor of 6. What does this mean? It means that masks don’t offer 100% protection, but they greatly reduce how much you’ll be exposed to the virus. And with Covid-19, it appears that the amount of your exposure is important. That’s why the virus spreads in clusters among co-workers, family members and – sadly – health care workers. The more exposed you are, the more likely you are to get infected. Reducing our exposure apparently reduces the risk to get infected.

Now Health experts are rethinking the guidelines. Several papers in scientific journals like Science and The Lancet recommend wearing masks. The head of the Chinese CDC said: “The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks.”

Masks are not just effective in protecting the wearer (ourselves), they are also crucial in protecting others by catching the droplets that transmit the virus. Natsuko told me: “In Japan, we are expected to wear a mask when we have a cold or don’t feel well, to protect others. And if the flu is especially bad, we also should wear a mask to protect ourselves.” The Coronavirus is not the flu, but it is also transmitted via droplets that we exhale.

In fact, the CDC has always recommended wearing a mask if you are infected. But we don’t know who is infected – that is why we have the current lockdown – so it makes sense for everybody to wear masks. That way, those who are infected, and don’t know it, will wear masks, too.

The CDC also recommends wearing masks when you are around somebody who is infected. Again, we don’t know who is infected, so we should wear masks when we meet anybody. And like immunizations, this works best when everybody works together to control the spread of the virus.

Masks add an extra layer to social distancing, reducing the exposure when we come too close for safety – which is unavoidable, for example, at a grocery store checkout counter. As an added benefit, masks remind us when we touch our faces – a habit that many of us have to break right now. (Resist the temptation to adjust your mask constantly – you should touch it as little as possible.)

Cyclists will understand the value of making small, but meaningful, performance improvements: A set of supple tires will not make you a world champion, but it’ll make a noticeable difference even on a casual ride. Even the most home-made mask provides more benefits than the ‘marginal gains’ that many cyclists are chasing.

You may wonder: Why did we get such strongly worded recommendations not to wear masks in the first place? There were two apparent reasons:

  • There is a shortage of masks, and the message that masks are ineffective was intended to prevent people from buying precious stocks. (They are needed for front-line health care workers.) That backfired, and hopefully, those responsible have learned the lesson that transparency is the best policy.
  • Officials worried about the economic impact of the crisis. Just a few weeks ago, Seattle’s mayor complained that news of the outbreak were scaring away tourists. People wearing masks would have been an very visible reminder that the virus was already spreading in our community. In hindsight, that might have been good. It might have create a sense of urgency that was lacking during the early days of the pandemic.

So we agree that masks are an effective tool in slowing the spread of the virus. Yet during the current shortage, there are no masks available. And the few masks that we have should go to the medical teams first. But we can make our own masks. Many already have taken the initiative to make much-needed masks for hospitals and nursing homes. What I suggest is that we expand this effort so that everybody comes out of the current lockdown with a mask or two.

How effective are home-made masks? A study found that home-made masks “significantly reduced the number of microorganisms expelled by volunteers.” In fact, the CDC now recommends that health care workers cover their mouth and nose with scarves when masks aren’t available. We certainly can do better than scarves!

So we now know that masks will be helpful in reducing the spread of the virus, especially after the current restrictions are eased. Let’s get to work making our own! And if you want to do more, make a few extra for your neighbors, friends and others. Some volunteers even make them for medical workers. If you know somebody who likes to sew, get them involved. Natsuko asked her mother to make a few masks. (Her mother was bored because her gym is closed and she is not supposed to meet her friends.) Natsuko’s mom enjoyed the task, and you see the result in the top photo.

FMB, the makers of tubular tires, has been making masks for a local residence for the elderly (above). The ultra-fine weave of the fabric used in tubular tires looks perfect for filtering out most droplets.

There are many patterns and instructions online, like this one. (Thanks, Machiko, for the link!) Sewing a mask is about the easiest sewing project you can do. If you don’t have a sewing machine, you can stitch it by hand.

You can use all kinds of fabric for the outer layer. Masks don’t have to be white or black… Making a mask for everybody during the next few weeks seems like a huge task, but it’s doable. And it will make a difference.

And we’ll keep thinking about what we can do to help. Because we’re all in this together!

20 Responses to Covid-19 Response: Making Face Masks

  1. Scott A March 28, 2020 at 6:28 pm #

    Great post! I really appreciate the reasoned tone and focus on personal responsibility & action within the community.

    Can you speak to what readily available fabrics are best for masks? Also, since the proposed masks are reusable, what are some guidelines for disinfection before reuse?

    • Jan Heine March 28, 2020 at 6:38 pm #

      From what I’ve read, you need to balance breathability with filtering droplets. So a dense weave is best. Some home-made masks have pockets for filters from vacuum cleaners and the like, but they can make it very hard to breathe.

      As to cleaning, the Japanese government has this video on how to clean face masks. It’s in Japanese, but it clearly shows the steps: Soak in water with laundry detergent, swish but don’t rub, rinse, and line dry. (Don’t use a dryer.) If you want to disinfect more, use some bleach.

  2. Chris Kostman March 28, 2020 at 7:20 pm #

    Having worked in China, I have to point out that your article leaves out the number one reason that Chinese (and likely Japanese) people often wear medical masks outside of medical settings: To keep the sun off their face, because being tan is considered low-class. Only peasants have something other than lily white skin on their face or elsewhere. That is the primary driver here.

    • Natsuko March 28, 2020 at 8:51 pm #

      As a Japanese I would like to explain about wearing face-masks. If we wore face-masks to avoid suntans, we would get very strange tanlines on our faces! We use UV protection lotion instead. We usually wear face-masks for protect other people or ourselves. We also wear face-masks to avoid pollen during allergy season.

      • Alan Xiao March 29, 2020 at 10:02 am #

        Thank you Natsuko. Having lived and worked in China, umbrellas, hats and long sleeves are used to shade sun, not face masks.

  3. Steve March 29, 2020 at 1:29 am #

    Thank you posting this. Great post!

  4. Steve Palincsar March 29, 2020 at 5:17 am #

    Natsuko, do your glasses fog up when you’re wearing a mask?

    • Natsuko March 29, 2020 at 11:28 am #

      Yes, they do. So I am not a big fan of wearing face-masks. If I was one of the Japanese women who love wearing face-masks, I would have bunch of face-masks to donate to local hospitals. Because they usually have some stock in their closets.:)

  5. Robert T March 29, 2020 at 4:15 pm #

    Great article and topic.

    I think masks are essential for everyone, 100% and without question.

    I’m a cancer surviver and patient, receiving monthly treatments (that are now on hold). The hospital has always required that anyone who has a sniffle, cough or is sick in anyway, wear a mask.

    Unfortunately, not everyone adheres to that, so I have always worn a mask in a hospital setting, because it can’t hurt. The primary intention of wearing a mask is to prevent the spread germs of a sick person to others, secondarily, it protects the wearer from airborne contaminants or viruses.

    Some will say that these “homemade” masks can’t filter down to the smallest micron, which is also said about the N95 masks.

    So you wear nothing? Makes no sense. I applaud your efforts, and hope to see everyone wearing masks, whether manufactured or made as you’ve done. I’ve had a reusable clothe mask I purchased last year to wear outside while doing yard work etc. ‘m now wearing it on my walks at all times. It’s far better than nothing.

    Thanks for sharing this.

  6. Owen March 29, 2020 at 4:48 pm #

    Thank you for sharing this, I don’t understand how it could be considered controversial. On the contrary, everything you write–in particular how the Japanese use masks–strikes me as much needed common sense. It’s a shame American politics and public health policy have come to this, but regardless I appreciate these simple instructions and advice back up by actual science.

    • Jan Heine March 29, 2020 at 5:54 pm #

      I am glad this post hasn’t been controversial at all. It’s a shame that poor planning led to such a shortage of protective gear. Let’s hope that in the future, the authorities will be more honest and direct by saying: “Please don’t buy masks. They are needed for medical teams right now.” (Actually, let’s hope that in the future, the lives of our medical teams won’t be endangered for the lack of equipment that costs just a few cents each.)

  7. Ted Durant March 29, 2020 at 6:30 pm #

    A timely post, as my wife has spent a fair amount of time this weekend cutting fabric for a friend who is making masks. It has become a little cottage industry. I passed through Sea-Tac airport a few weeks and was interested to see how few people were wearing masks. It was also interesting to see (admittedly on a small sample count) that _every_ person I saw wearing a mask was a person of color. I know I’ll be incredibly self-conscious the first time I go out wearing one, but I’m also confident I’ll quickly adjust to it.

  8. Champs March 29, 2020 at 6:54 pm #

    My controversial two cents are that Westerners and especially Americans would throw away masks like Kleenex if they were told that masks are good personal protection; The benefit is undersold to prevent overuse.

  9. Katia March 30, 2020 at 5:33 am #

    Bravo for this article. In France, wearing a mask was frowned upon until now. During the H1N1 epidemic, it attracted reproving looks. But this crisis seems to change mentalities. The Grenoble University Hospital has published a tutorial on how to make a fabric mask and the crafters community and textile manufacturers are making them. We are trying to help by distributing it to cashiers or other non-care workers who need it in our neighbourhood.

  10. Mark Lohmann March 30, 2020 at 6:32 am #

    Great idea! My wife works as an MD here in Sweden and they have a protective visor shortage, so we’ve been making these (better than nothing category):

    https://www.facebook.com/martin.oberg.129/videos/10157315913099773/?eid=ARDWQpNypsaqNpCAHubxi6sGC6DaQUd-LZcetYlGoYxBMeo0YYQTKg6rRJY6xX5bZ90PeGfvlly9FWO0

  11. Thomas March 30, 2020 at 8:27 am #

    Dear Jan,

    I can understand the urge to “fight” the virus with every tool you have.
    BUT do you have proof (speaking of medical studies with proper statistics) for the effect of wearing simple masks made of cotton?
    The linked study shows only very little effect (“better than nothing”).

    You have a series of cycling myths, where you could show that there ist no statistical proof (lost in the noise) or there is no link between cause and effect.

    Could you use this aproach with cotton masks too?

    Kind regards, thomas

    • Jan Heine March 30, 2020 at 9:48 am #

      It’s great to be a skeptic, but the risk of inaction far outweighs the inconvenience of action right now. That is why we are practicing social distancing, even though I suspect that there are no controlled studies – yet! – that it works. I am not a medical researcher, and now is hardly the time to run a field test with hundreds of volunteers, half wearing masks and half not wearing masks, that you then expose to Covid-19.

      We know that the virus is transmitted via droplets, and everything we’ve seen indicates that more exposure increases the risk of developing serious symptoms. Catching those droplets before they are airborne is the idea behind masks. Fewer droplets will mean fewer infections.

      If you want an analogy from the cycling world, it’s like decreasing your frontal area on a bike – we don’t need much study to know this will make you more aerodynamic in 98% of cases. (The exception is when the smaller shape has a much-worse drag coefficient, but that is very rare.)

      The requirement that all medical staff must wear surgical masks when interacting with patients is based on studies showing that this significantly reduces the risk of infections. In fact, a major problem we are facing in the U.S. right now is that there aren’t enough masks for medical staff. If we could get masks on the cashiers in grocery stores and other ‘front-line’ workers, it would further help with the attempts at social distancing.

      If you’d like more on this topic, I found this article, by an information scientist, in the New York Times on ‘Why Telling People They Don’t Need Masks Backfired.’

      • Thomas March 30, 2020 at 1:57 pm #

        Dear Jan,

        some might call it skepticism, I try do think of evidence based action or medicine.
        I did applaud to your post about distancing. It was about caution and it obviously was based on science and statistics. And it was ahead of the time.
        But the word about wearing cotton masks is “controversial” (using your word).
        There might be a little bit of gain of cotton masks in a number of actions like washing your hands, decency (using your ellbow pit for coughing and szneezing), massive testing, tracking of affected people and those who had contact, distancing and so on.
        Most of these actions are hard to see in public, but not wearing a mask (of what ever make) is easily detected. Even if the one person might be more caring in all but the one aspect. Or she/he is immune and there is no need for a mask any more.
        As you have a german origin, you know about the things that are associated with the term “Blockwart”. Do we need to push that?

        Yes, everybody in the medical teams should have proper protection (FFP3, shields or glasses), but I doubt they would opt for cotton mask, unless it is a real mess.

        Going back to your analogy about aerodynamics in cycling: Dropping your stem or the aero tuck will most definitely help, even the aerodynamic frames or handlebars the industry tries to sell might help.
        But what is the price for the gain?

        And talking science again: https://www.ebm-netzwerk.de/en/publications/covid-19

        Mit freundlichen Grüßen, bleib(t) gesund!

        • Jan Heine March 31, 2020 at 8:39 am #

          I appreciate your comments. I think one factor here is that many western people may have a strong cultural aversion to covering your face in public – something that may also underlie the French resistance to women wearing veils. However, the virus is a real threat, and we have to overcome this reluctance.

          Fortunately, we’re not alone in calling for masks any longer. Yesterday, the Washington Post reported that the CDC is discussing recommending masks for everybody who has to interact with others – specifically home-made masks, because they are still afraid that people might be able to find masks that otherwise could go to medical teams that desperately need them.

  12. David March 30, 2020 at 8:54 pm #

    I’m a biomedical researcher and I agree completely with your post. Here are two studies that show even homemade masks can reduce transmission of particulates and infectious organisms. Both are small scale studies, but both incorporate methods to quantitate the effects. And both conclude that homemade masks do offer a benefit, even if not as effective as surgical masks or more sophisticated equipment.

    https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/testing-the-efficacy-of-homemade-masks-would-they-protect-in-an-influenza-pandemic/0921A05A69A9419C862FA2F35F819D55

    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0002618